Irritability of the Bladder.
Definition:—An irritability of the walls of the bladder, or of the sphincter, of nervous origin, independent of local conditions.
Pathology:—This condition occurs independently of any of the diseases which have been previously described. The only pathological evidences present are extreme redness or greatly increased vascularity observed through the cystoscope; a localized hyperemia, from hyperesthesia, either of the nerve centers, or of the terminal filiments of the nerves distributed to the mucous membrane of the bladder. The condition must be distinguished from that caused by strongly acid or alkaline urine.
Etiology:—It is more common in nervous and hysterical women, or in neurotic males. The patient is poorly nourished, has but little appetite, is usually persistently constipated, suffers from mental depression or melancholia, is peevish and fretful, and is apt to complain of being in constant pain, or suffers from imaginary attacks of neuralgia or rheumatism, which are located in various portions of the body. The condition may occur after long mental exertion during an overwrought condition of the nervous system, or when there is both physical and mental exhaustion from overwork. It results also from menstrual irregularities, and from digestive faults, and other nutritional difficulties, and is present often with alcoholics.
Symptomatology:—Usually there is general nervous irritability, with occasional headaches, or chronic gastric disorder. The immediate symptoms are frequent urination, with pain. The pain varies in character from simple burning or scalding, to severe, sharp, cutting pain. Occasionally there is urethral spasm, more or less severe, with straining and an unsatisfied desire after urinating. In other cases, there is a lack of control of the sphincters. The desire occurs abruptly, and the urine passes .very quickly afterward, and is not controlled by the patient. In some cases there is diffused soreness over the entire walls of the bladder, or in the peritoneum, which occasionally amounts to pain, although it is not usually severe.
Treatment:—The cure of these cases depends upon the recognition of the cause, and its removal. Often it will be sufficient for the patient to take a rest, to eat plain, unseasoned, food, and drink freely of water. In a number of cases, attention must be paid to the urine, and all irritating elements must be overcome. Nerve sedatives will then usually relieve the local irritation. Cimicifuga, gelsemium and hydrangea have been those upon which I have placed the most reliance. Five drops of rhus aromatic in four ounces of a mild infusion of triticum or marshmallow, taken before meals and at bed time, will effect a cure in many cases. Five grains of the citrate of lithium with one drop of specific apis, every two or three hours, will relieve those cases where there is a sensation of heat and burning. Eryngium and chimaphila will cure those cases where there is a tendency to local inflammation from the reflex irritability.
It is necessary that these patients should have constitutional treatment. The stomach must be restored to a normal condition and the nervous system must be built up. Hydrastis, phosphorus, and some well selected preparation of iron, will usually accomplish these results, in proper time, if the patient is relieved from exhausting labor and care, and will take an abundance of outdoor exercise.
